> ## Documentation Index
> Fetch the complete documentation index at: https://mso.getlemma.com/llms.txt
> Use this file to discover all available pages before exploring further.
# Submit clean claims
> The clean-claim checklist, scrubber configuration, same-day rejection handling, and the eight data points that cause most first-submission failures.
A **clean claim** is one accepted by the payer on first submission and adjudicated without a denial. A 95%+ clean claim rate is achievable, and getting there is mostly about data discipline upstream rather than anything the biller does at submission.
## Prerequisites
* Payer contract executed, clinician credentialed, effective dates known
* EDI enrollment approved for the payer
* Eligibility verified and the 271 saved
* Authorization obtained and **captured in the structured field**
* Encounter documented and coded
## The clean-claim checklist
Run before submission, ideally as automated scrubber edits rather than human review.
### Entity and provider data
* [ ] **Billing provider legal name** matches the payer's records exactly, same as the CP 575 and W-9
* [ ] **Billing provider NPI** is the correct entity's Type 2 in a multi-PC group
* [ ] **Tax ID** matches the enrollment
* [ ] **Taxonomy** matches what you enrolled and contracted with
* [ ] **Rendering provider NPI** is credentialed and linked to this group's contract
* [ ] **Service date is on or after** the later of contract effective date and provider effective date
* [ ] **Referring provider** present where the payer requires it
### Patient and subscriber data
* [ ] Subscriber ID exactly as printed, **including any alpha prefix**
* [ ] Name matches the payer's record, legal name, not a nickname
* [ ] Date of birth matches
* [ ] Relationship code correct
* [ ] Address current
* [ ] Coordination of benefits reflected if there is other coverage
### Clinical and coding data
* [ ] Diagnosis codes valid and specific to the highest available level
* [ ] Procedure codes valid for the date of service
* [ ] Modifiers present and appropriate
* [ ] Diagnosis pointers link each line to a supporting diagnosis
* [ ] Units correct
* [ ] **Place of service** correct, especially telehealth 02 vs 10
* [ ] **Prior authorization number** present where required
* [ ] Charges consistent with the fee schedule
## Configure the scrubber
Scrubber rejections are free. Payer denials cost 30–60 days. Push everything you can into automated edits.
| Edit | Blocks |
| --------------------------------------------------- | ------------------------------------------------------------------------------------------------------- |
| **Auth required and missing** | The single highest-value edit, see [Get prior authorizations](/guides/billing/get-prior-authorizations) |
| Rendering provider not credentialed with this payer | Enrollment denials |
| Service date before provider effective date | Same |
| Taxonomy mismatch against enrollment | Mysterious denials |
| Missing modifier where a code pair requires one | Bundling denials |
| Invalid code combination (NCCI-style edits) | Unbundling findings |
| Missing referring provider where required | |
| Invalid place of service for the code | |
| Diagnosis pointer missing or invalid | |
| Charge below the contracted allowed amount | You cannot be paid more than you bill |
**Prefer structural edits to checklist items.** A scrubber edit works when your biller is out. A checklist item depends on a person having a good day.
## Handle rejections same-day
Two acknowledgments come back, and neither is a denial:
| | 999 | 277CA |
| ----------------------------- | ------------------------------ | ---------------------------------------------------- |
| **From** | Clearinghouse or payer | Payer |
| **Says** | Whether the file was valid X12 | Whether the claim was **accepted into adjudication** |
| **A rejection means** | Format problem | The payer's front end refused the claim |
| **Was anything adjudicated?** | No | No |
| **Appeal rights?** | None | None, there is nothing to appeal |
**A 277CA rejection is not a denial.** Nothing was adjudicated and no determination was made. Correct the data and resubmit as a new claim — do **not** use a corrected-claim frequency code, because there is no original claim in the payer's system to correct.
And do not appeal it. There is nothing to appeal.
Work rejections **first thing every morning**, before anything else. They are the cheapest problems available and they age toward timely filing limits.
## The eight causes of most first-claim failures
For a new group or a new payer, in order:
1. **Billing provider NPI not recognized**, EDI enrollment incomplete
2. **Legal name mismatch** across the W-9, CP 575, NPPES, and the claim
3. **Taxonomy mismatch** with the enrollment
4. **Rendering provider not credentialed** or not linked to the group contract
5. **Service date before the provider's effective date**
6. **Subscriber ID wrong**, transposed digits, missing alpha prefix
7. **Missing authorization number** on a service that required one
8. **Invalid place of service**, the telehealth codes especially
Six of eight are **enrollment** problems. First-claim failures are usually enrollment failures wearing a billing costume. See [Set up EDI, ERA, and EFT](/guides/enrollment/set-up-edi-era-eft).
## Corrected claims
To fix a claim that was **adjudicated** (denied or paid incorrectly):
* Resubmit with the appropriate **claim frequency code**, 7 for replacement, 8 for void
* Reference the **original claim number**
* Correct only what needs correcting
**Never resubmit an adjudicated claim as a new original claim.** It will deny as a duplicate (CARC 18), you will have burned the time, and you may run out the correction window.
## Steps
Days in AR starts at charge entry.
Every one. An overridden edit is a denial you chose.
Any completed visit without a charge is revenue that may never exist.
## Verify it worked
* [ ] Clean claim rate 95%+
* [ ] Charges entered within one business day
* [ ] Scrubber edits configured, including the auth-required edit
* [ ] No edits routinely overridden
* [ ] Rejections worked same-day
* [ ] Unbilled encounters at zero daily
* [ ] Rejection causes tagged and trending down
## Common failure modes
| Failure | Consequence |
| ---------------------------------------- | --------------------------------------- |
| Treating a 277CA rejection as a denial | Wasted appeals; claim never resubmitted |
| Resubmitting an adjudicated claim as new | CARC 18 duplicate denial |
| Overriding scrubber edits routinely | Chosen denials |
| Charge entry lag | Days in AR; timely filing risk |
| Rejections worked weekly | Aging toward filing limits |
| Unbilled encounters unmonitored | Revenue that never becomes a claim |
## Related topics
- [Step 10: Submit your first claim](/start/zero-to-paid/submit-your-first-claim.md)
- [Verify eligibility and benefits](/guides/billing/verify-eligibility.md)
- [Get prior authorizations](/guides/billing/get-prior-authorizations.md)
- [Work the denial queue](/guides/billing/work-the-denial-queue.md)
- [The 837: how claims are told to payers](/concepts/payments/understanding-837s.md)
- [The life of a claim](/concepts/payments/claim-lifecycle.md)
- [837 file anatomy](/reference/edi/837-anatomy.md)
- [Place of service codes](/reference/edi/place-of-service-codes.md)